Project Summary/Abstract. Despite the existence of several evidence-based asthma treatments, and increased understanding of effective community-based interventions for high-risk pediatric populations, childhood asthma disparities persist. Richmond is often cited as the ?Asthma Capital? of the U.S. by the Allergy and Asthma Foundation of America, and is consistently identified as one of the most challenging places to live with asthma. To date, however, there is no comprehensive, community-engaged asthma care program for those children at highest risk for poor asthma outcomes. To address this urgent public health concern, our investigative team conducted a year-long, mixed-methods community needs assessment (U34HL130759). Key priority areas that emerged included peer support, advocacy, treating the home as a system, increased school nurse education, and coordination with schools and providers. Our community-engaged team translated the needs assessment findings to a program, RVA Breathes, that coordinates asthma care across four sectors: the family, home, community, and medical care. RVA Breathes includes family-based asthma self-management education (delivered by Community Health Workers [CHWs] with the Institute for Public Health Innovation), home environmental remediation (with Richmond City Health District?s Healthy Homes Initiative), and a school nurse component (with elementary schools in the Richmond City Public School System). These interventions capitalize among existing resources and relationships with stakeholders in Richmond, each of which is committed to RVA Breathes. Three-hundred children with asthma and their caregivers will participate in a randomized clinical trial of RVA Breathes. After completing a baseline assessment, families will be randomized to one of three conditions: 1) asthma education + home remediation + school intervention, 2) asthma education + home remediation and 3) comparator condition (Enhanced Standard of Care, E-SOC). Families will participate in the program for 12 months and complete follow-up assessments (post-treatment and 3-, 6-, and 12-months) to measure changes in healthcare utilization and the impact of the program on child asthma outcomes. Conditions will be compared on the primary outcomes of healthcare utilization, including asthma-specific ED visits and hospital admissions, as well as school absences and medication usage; secondary outcomes include asthma control, symptoms, and quality of life. We will also evaluate the sustainability of RVA Breathes after 12 months (without active intervention), including a review of qualitative data from participants and stakeholders in the program. Findings from this trial will allow for dissemination and implementation of RVA Breathes as a sustainable program in the Richmond area. !